Lifestyle factors related to prevalent chronic disease multimorbidity: A population-based cross-sectional study

Global trends in chronic kidney disease mortality and disability-adjusted life years attributable to low physical activity (1990-2021): a growing public health challenge

BACKGROUND

Low physical activity (LPA) is a major contributor to the global burden of chronic kidney disease (CKD). Our goal was to assess the spatiotemporal trends in the CKD burden attributable to LPA from 1990 to 2021, with a focus on the globe, China, five SDI regions, and four continents.

METHODS

We analysed CKD-related deaths, DALYs, the ASMR, the ASDR, and the EAPC attributable to low physical activity (LPA). This study focused on trends from 1990 to 2021 across the globe, China, five SDI regions, and four continents. Decomposition analysis, frontier analysis, and forecasting models were employed to explore changes in these indicators and their influencing factors.

RESULTS

In 2021, CKD attributable to low physical activity (LPA) resulted in 913,070 [95% UI: 348,170-1,619,770] DALYs and 40,920 [95% UI: 16,170-72,560] deaths globally, both of which were higher than those reported in 1990. The AOSD increased from 9.63 (95% UI: 3.73-17.02) to 10.81 (95% UI: 4.14-19.18) per 100,000, with an EAPC of 0.42 (95% CI: 0.35-0.48). The ASMR increased from 0.42 (95% UI: 0.17-0.74) to 0.50 (95% UI: 0.20-0.90) per 100,000, with an EAPC of 0.65 (95% CI: 0.57-0.73). The burden was greater among females, with more rapid increases in the ASDR and ASMR. The Americas and high-SDI regions presented the greatest growth in DALY and mortality rates.

CONCLUSIONS

The burden of CKD attributable to low physical activity (LPA) has increased significantly, particularly in low-SDI regions, women, and elderly individuals. The findings highlight the importance of promoting physical activity and implementing early interventions to inform public health policies.

CLINICAL TRIAL NUMBER

Not applicable.

Factors associated with dementia risk reduction lifestyle in mild cognitive impairment: a cross-sectional study of individuals and their family caregivers

OBJECTIVE

A healthy lifestyle has been shown to mitigate cognitive decline in patients with mild cognitive impairment, with family caregivers playing a pivotal role in the patients' lifestyle management. Exploring the level of dementia risk reduction lifestyle and the influencing factors at both the patient and caregiver levels in patients with mild cognitive impairment is crucial for identifying strategies to improve patients' lifestyles and delay disease progression.

METHODS

Using a convenience sampling method, 302 patients with mild cognitive impairment and their family caregivers admitted to the neurology departments of four tertiary care hospitals in China, from December 2024 to February 2025 were recruited and surveyed using a general information questionnaire, the Dementia Risk Reduction Lifestyle Scale (DRRLS), the Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction scale (MCLHB-DRR), the Perceived Social Support Scale (PSSS), and the Mutuality Scale (MS). Multiple linear regression was used to analyze the factors influencing the dementia risk reduction lifestyle of patients.

RESULTS

DRRLS score of 83.61 ± 16.13, multiple linear regression showed that the patient's monthly individual income, the presence of chronic disease, health beliefs, and social support were independent influences on their dementia risk reduction lifestyle. Furthermore, the lifestyle and mutuality of family caregivers were also independent influences on dementia risk reduction lifestyle in patients. The final model explained 75.5% of the variance in the lifestyle.

CONCLUSIONS

Patients with mild cognitive impairment have a general level of dementia risk reduction lifestyle. The characteristics of both patients and caregivers collectively influence the patients' lifestyle. Healthcare providers should conduct early dyadic assessments and develop targeted dyadic intervention strategies based on influencing factors to improve patients' lifestyles and help them delay disease progression.

Interplay of health-related quality of life and comorbidities in people with type 2 diabetes mellitus treated in primary care settings in Austria: a countrywide cross-sectional study

OBJECTIVES

This study assessed the health-related quality of life (HRQoL) and its relationship with clinical factors and comorbidities in people with type 2 diabetes mellitus (T2DM) treated in primary care settings.

DESIGN

Cross-sectional study design: This study assessed the HRQoL using a 36-item Short Form Survey (SF-36) tool in eight domains. The HRQoL scores ranged from 0% to 100% for each domain, with higher scores indicating better HRQoL. Linear regression was used to assess the association of HRQoL domain scores with clinical covariates and comorbidities.

SETTING

A countrywide study was conducted on individuals with established T2DM (N=635) attending primary healthcare services for various conditions across nine federal states of Austria from 2021 to 2023.

PARTICIPANTS

A total of 635 individuals, aged above 50 years and diagnosed with T2DM, were recruited by the attending physician to evaluate their HRQoL in relation to T2DM and its associated comorbidities.

RESULTS

The mean SF-36 scores for physical functioning (69±28), role-physical (62±42), mental health (72±20), role-emotional (73±41), social functioning (79±25), bodily pain (67±28) and vitality (55±22) were satisfactory, except for general health (41±10). Age and body mass were inversely associated with physical, mental and social HRQoL (p<0.05). Women had lower mental health (β: -5.44 [95% CI -9.43 to -1.44], p<0.05) than men. Smokers and those with cardiovascular and chronic lung diseases reported worse general, mental and physical health and vitality (p<0.05 each). Depression (p<0.001) and multimorbidity (p<0.05) severely deteriorated all HRQoL domains: physical functioning (Depression:-25.34 [95% CI -33.84 to -16.84], p<0.001); (Multimorbidity: -19.37 [95% CI -26.30 to -12.44], p<0.001), physical role limitations (-22.96 [95% CI -36.65 to -9.27], p<0.001); (-18.53 [95% CI -29.59 to -7.48], p<0.001), social functioning (-24.38 [95% CI -32.41 to -16.35], p<0.001); (-8.86 [95% CI -15.66 to -2.07], p<0.05), emotional well-being (-19.80 [95% CI -26.22 to -13.38], p<0.001); (-9.54 [95% CI -14.95 to -4.13], p<0.001), emotional role limitations (-28.26 [95% CI -41.01 to -15.52], p<0.001); (-8.15 [95% CI -18.78 to 2.49], p=0.133), bodily pains (-23.09 [95% CI -32.21 to -13.97], p<0.001); (-14.52 [95% CI -22.08 to -6.95], p<0.001), fatigue (-16.47 [95% CI -23.40 to -9.55], p<0.001); (-13.71 [95% CI -19.39 to -8.03], p<0.001), general health (-7.09 [95% CI -10.40 to -3.78], p<0.001); (-7.14 [95% CI -9.83 to -4.46], p<0.001).

CONCLUSIONS

Our analysis showed that advanced age, obesity, depression, cardiovascular disease, chronic lung diseases and multimorbidity were associated with poor HRQoL of individuals with T2DM at the primary care level. These findings highlight the need for strengthening holistic management in primary care to address the diverse physical, social and emotional needs of individuals with T2DM.

The Application of Checklist in Chronic Disease: A Comprehensive Bibliometric Analysis

Background

Increasing evidence suggests that checklist plays an important role in chronic disease. This study aims to use bibliometric methods to explore the evolving global research trends, hotspots, and emerging frontiers of the application of checklist in chronic disease research, providing deeper insights into the current research landscape and guiding future chronic disease management development efforts.

Methods

Bibliometrics analysis was performed utilizing RStudio and VOSviewer software. This atlas analyzed the global research trends, hotspots and emerging trends.

Results

In total, there were 408 publications authored by 2398 authors from 784 institutions and 53 countries, published in 274 journals. The USA led in publication numbers, international cooperation and societal impact. The leading core journal was Archives of Pathology & Laboratory Medicine. The first highly cited document was published in Psychological Assessment by Bovin MJ et al. Chronic disease management, and the validity of treatment and recovery were the hotspots and potential trends.

Conclusion

This study provides a comprehensive bibliometric analysis of the application of checklist in chronic disease research, uncovering global research trends and current hotspots while offering valuable insights and references for future research directions.

Care cascades of diabetes and hypertension among late adolescents in India

Background

Diabetes and hypertension are the most prevalent morbidities in India and are quickly becoming common among the younger age groups. Adolescents aged 10-19 years, accounting for one-fifth of the country's population, are at an increasing risk of developing these conditions. We aim to examine the prevalence, awareness, treatment, and control (ATC) of diabetes and hypertension among late adolescents (15-19 years) in India.

Methods

We used microdata of 204 346 late adolescents from India's fifth round of the National Family and Health Survey, 2019-21. We defined hypertensive adolescents as those diagnosed with hypertension or those with a systolic blood pressure (BP) measurement of ≥130 mm Hg, diastolic BP measurements of levels ≥80 mm Hg, or those who used medication to lower BP at the time of the survey. Diabetic adolescents were those diagnosed as such by health professionals, those with glucose levels above 140 mg/dL, or those taking any medication to control high blood glucose levels at the time of the survey. We estimated the age-sex-adjusted prevalence of both conditions and their ATC rates, referred to as cascade care. We used the Erreygers' Concentration Index to examine the socioeconomic inequality in cascade care. We used multivariable logistic regression to estimate the average marginal effects while controlling for sociodemographic characteristics.

Results

Of 204 346 late adolescents, 27.8% (95% confidence interval (CI) = 27.6, 28.2) had either of the two conditions, with 3.5% (95% CI = 3.4, 3.6) being diabetic and 24.3% (95% CI = 24.0, 24.6) having hypertension. The ATC rate of diabetes was 13.5% (95% CI = 12.4, 14.7), 13.1% (95% CI = 11.9, 14.2), and 12.1% (95% CI = 11.0, 13.3), respectively. For hypertension, the ATC rate was extremely low at 6.2% (95% CI = 5.8, 6.5), 3.5% (95% CI = 3.3, 3.7), and 3.3% (95% CI = 3.1, 3.5), respectively. There was a pro-rich socioeconomic inequality in the prevalence of hypertension and a pro-poor inequality in the prevalence of diabetes among late adolescents. We observed significant variations in both conditions across the regions of India.

Conclusions

The high prevalence and low care cascade levels of diabetes and hypertension among late adolescents in India are concerning. A multipronged strategy that includes screening, diagnosis, and timely interventions at school and home can reduce the burden of hypertension and diabetes among the prospective workforce in India. Sensitising adolescents through school curricula under the New Education Policy (2020) is recommended to reduce the burden of these conditions. We also recommend that longitudinal and intervention studies focussed on this age group be undertaken in the future to help reduce the disease burden.

Prevalence of chronic conditions in masters games athletes: predictors and comparison to the general population

Background

Masters athletes (MA) are typically considered healthier than age-matched non-athletes. However, limited evidence exists on the prevalence of chronic conditions in MA.

Methods

Masters athletes competing at the 2017 Australian Masters Games (n = 4,848) and 2018 Pan Pacific Masters Games (n = 14,455) were invited to complete a survey collecting demographic and health information focused on chronic conditions. Age- and sex-adjusted prevalence of selected chronic conditions in MA was compared with Australian general population data.

Results

Overall, 817 MA (53.7 ± 10.6 y, 61% female) completed the survey with 48% reporting ≥1 chronic condition. Cardiovascular conditions were less prevalent in MA vs. the general population (11%, 95% CI [9-14%] vs. 30%), as were cardiovascular risk factors, anxiety, asthma, cancers, and depression. The prevalence of osteoarthritis in MA was, however, similar (11%, 95% CI [9-14%] vs. 14%). Older (>50 yr) vs. younger MA were more likely to report osteoarthritis (OR 2.17, 95% CI [1.35-3.48]) and heart conditions (OR 1.85, 95% CI [1.11-3.07]), while younger vs. older MA were more likely to report mental health conditions (OR 1.86, 95% CI [1.23-2.82]). Prevalence of mental health conditions was higher in female vs. male MA (17% 95% CI [13-20%] vs. 8% 95% CI [5-11%]) and younger vs. older MA (18% vs. 10%). Employed MA were less likely than MA who were not employed to report having one or more cancers (OR 0.33, 95% CI [0.16-0.69]), cardiovascular conditions (OR 0.47, 95% CI [0.29-0.79]) and hypertension (OR 0.36 95% CI [0.18-0.73]).

Conclusions

Cardiovascular and other chronic conditions prevalence was lower in MA compared to age-matched non-athletes, highlighting the value of promoting sport involvement in aging individuals as well as for continuation of participation in younger age groups into MA level. Greater participation of younger and female groups in masters sport to improve mental health, and inclusion of people who are not employed should be supported.

Lifestyle Factors in the Clinical Manifestation and Management of Atopic Dermatitis

Atopic dermatitis (AD), also known as eczema, is an inflammatory dermatologic condition that results in inflamed, itchy skin lesions. The development of this condition is governed by a variety of genetic and environmental factors including lifestyle habits. The severity of atopic dermatitis has been attributed to be affected by various lifestyle factors, prompting the interest in utilizing lifestyle modifications as a form of treatment for atopic dermatitis symptoms. Many research studies have been conducted to investigate the effects of different factors such as sleep, stress, diet, smoking and tobacco use, exposure to various temperatures and humidity levels, and skincare and cosmetic products on atopic dermatitis symptoms, and how certain habits can be modified to manage AD conditions. Current studies have demonstrated the significant impact some lifestyle modifications can elicit with improving atopic dermatitis, while also discussing other lifestyle factors that require further research to determine their effects on AD. This review article summarizes the findings in the current literature that investigates the role of different lifestyle habits on the severity and exacerbation of atopic dermatitis, and explores the mechanisms in which these behaviors can trigger AD.

Multisource Data Framework for Prehospital Emergency Triage in Real-Time IoMT-Based Telemedicine Systems

BACKGROUND AND OBJECTIVE

The Internet of Medical Things (IoMT) has revolutionized telemedicine by enabling the remote monitoring and management of patient care. Nevertheless, the process of regeneration presents the difficulty of effectively prioritizing the information of emergency patients in light of the extensive amount of data generated by several integrated health care devices. The main goal of this study is to be improving the procedure of prioritizing emergency patients by implementing the Real-time Triage Optimization Framework (RTOF), an innovative method that utilizes diverse data from the Internet of Medical Things (IoMT).

METHODS

The study's methodology utilized a variety of Internet of Medical Things (IoMT) data, such as sensor data and texts derived from electronic medical records. Tier 1 supplies sensor and textual data, and Tier 3 imports textual data from electronic medical records. We employed our methodologies to handle and examine data from a sample of 100,000 patients afflicted with hypertension and heart disease, employing artificial intelligence algorithms. We utilized five machine-learning algorithms to enhance the accuracy of triage.

RESULTS

The RTOF approach has remarkable efficacy in a simulated telemedicine environment, with a triage accuracy rate of 98%. The Random Forest algorithm exhibited superior performance compared to the other approaches under scrutiny. The performance characteristics attained were an accuracy rate of 98%, a precision rate of 99%, a sensitivity rate of 98%, and a specificity rate of 100%. The findings show a significant improvement compared to the present triage methods.

CONCLUSIONS

The efficiency of RTOF surpasses that of existing triage frameworks, showcasing its significant ability to enhance the quality and efficacy of telemedicine solutions. This work showcases substantial enhancements compared to existing triage approaches, while also providing a scalable approach to tackle hospital congestion and optimize resource allocation in real-time. The results of our study emphasize the capacity of RTOF to mitigate hospital overcrowding, expedite medical intervention, and enable the creation of adaptable telemedicine networks. This study highlights potential avenues for further investigation into the integration of the Internet of Medical Things (IoMT) with machine learning to develop cutting-edge medical technologies.

Proposed mechanisms of action participating in the hypoglycemic effect of the traditionally used Croton guatemalensis Lotsy and junceic acid, its main compound

Croton guatemalensis Lotsy (Euphorbiaceae) is an important traditional medicine that is used by the Cakchiquels of Guatemala to control hyperglycemia in patients with type 2 diabetes. Previous studies have shown that administration of this plant induces an acute hypoglycemic effect during fasting and that the main compound is junceic acid, a diterpenoid with a clerodane skeleton; however, junceic acid has not been reported to have hypoglycemic activity in the literature. As the mechanisms involved in the hypoglycemic effect of C. guatemalensis remain unknown, the objective of the present investigation was to elucidate the hypoglycemic mechanisms of this species, as well as its major compound, junceic acid. The results indicated that, similar to complete extract, junceic acid exhibited a hypoglycemic effect in hyperglycemic rats. Both C. guatemalensis extract and junceic acid inhibited the activity of two rate-limiting enzymes involved in hepatic glucose production; however, compared with chlorogenic acid, junceic acid had a more potent effect on glucose-6-phosphatase levels than chlorogenic acid, which was used as a positive control. Furthermore, both fasting and postprandial insulin levels decreased in healthy and hyperglycemic rats despite reduced blood glucose levels in both metabolic states, suggesting a potential insulin-sensitizing effect. However, neither of these compounds potentiated the effect of insulin in insulin tolerance tests nor inhibited the enzyme activity of protein tyrosine phosphatase 1B, a negative regulator of the insulin pathway. Therefore, the insulin-sensitizing effect is thought to be independent of insulin and mediated by potential activation of the AMP-activated protein kinase pathway. The specific activation of this master regulator in β-cells results in the inhibition of insulin secretion in a healthy state and the restoration of the insulin response under conditions of glucotoxicity; these effects were observed after the administration of the extract and junceic acid in healthy and hyperglycemic rats. Overall, the main findings of this study establish a basis of the mechanisms of action of C. guatemalensis and its main compound, junceic acid, in terms of their hypoglycemic effect.

Ultraprocessed Food Consumption and Cardiometabolic Risk Factors in Children

IMPORTANCE

High intake of ultraprocessed foods (UPFs) has been associated with higher cardiometabolic risk in adults; however, the evidence in children is limited.

OBJECTIVE

To investigate the association between UPF consumption and cardiometabolic risk factors in the Childhood Obesity Risk Assessment Longitudinal Study (CORALS).

DESIGN, SETTING, AND PARTICIPANTS

This baseline cross-sectional analysis was conducted using the data of CORALS participants recruited between March 22, 2019, and June 30, 2022. Preschool children (aged 3-6 years) were recruited from schools and centers in 7 cities in Spain. Inclusion criteria included informed consent signed by parents or caregivers and having a completed a set of questionnaires about the child's prenatal history at home. Exclusion criteria included low command of Spanish or unstable residence.

EXPOSURE

Energy-adjusted UPF consumption (in grams per day) from food frequency questionnaires and based on the NOVA food classification system.

MAIN OUTCOMES AND MEASURES

Age- and sex-specific z scores of adiposity parameters (body mass index [BMI], fat mass index, waist-to-height ratio, and waist circumference) and cardiometabolic parameters (diastolic and systolic blood pressure, fasting plasma glucose, homeostasis model assessment for insulin resistance, high-density and low-density lipoprotein cholesterol, and triglycerides) were estimated using linear regression models.

RESULTS

Of 1509 enrolled CORALS participants, 1426 (mean [SD] age, 5.8 [1.1] years; 698 boys [49.0%]) were included in this study. Mothers of children with high UPF consumption were younger, had a higher BMI, were more likely to have overweight or obesity, and had lower education levels and employment rates. Compared with participants in the lowest tertile of energy-adjusted UPF consumption, those in the highest tertile showed higher z scores of BMI (β coefficient, 0.20; 95% CI, 0.05-0.35), waist circumference (β coefficient, 0.20; 95% CI, 0.05-0.35), fat mass index (β coefficient, 0.17; 95% CI, 0.00-0.32), and fasting plasma glucose (β coefficient, 0.22; 95% CI, 0.06-0.37) and lower z scores for HDL cholesterol (β coefficient, -0.19; 95% CI, -0.36 to -0.02). One-SD increments in energy-adjusted UPF consumption were associated with higher z scores for BMI (β coefficient, 0.11; 95% CI, 0.05-0.17), waist circumference (β coefficient, 0.09; 95% CI, 0.02-0.15), fat mass index (β coefficient, 0.11; 95% CI, 0.04-1.18), and fasting plasma glucose (β coefficient, 0.10; 95% CI, 0.03-0.17) and lower HDL cholesterol (β coefficient, -0.07; 95% CI, -0.15 to -0.00). Substituting 100 g of UPFs with 100 g of unprocessed or minimally processed foods was associated with lower z scores of BMI (β coefficient, -0.03; 95% CI, -0.06 to -0.01), fat mass index (β coefficient, -0.03; 95% CI, -0.06 to 0.00), and fasting plasma glucose (β coefficient, -0.04; 95% CI, -0.07 to -0.01).

CONCLUSIONS AND RELEVANCE

These findings suggest that high UPF consumption in young children is associated with adiposity and other cardiometabolic risk factors, highlighting the need for public health initiatives to promote the replacement of UPFs with unprocessed or minimally processed foods.

Aging hallmarks, biomarkers, and clocks for personalized medicine: (re)positioning the limelight

The rapidly increasing aging prevalence, complexity, and heterogeneity pose the scientific and medical communities in front of challenges. These are delivered by gaps between basic and translational research, as well as between clinical practice guidelines to improve survival and absence of evidence on personalized strategies to improve functions, wellbeing and quality of life. The triumphs of aging science sheding more and more light on mechanisms of aging as well as those of medical and technological progress to prolong life expectancy are clear. Currently, and in the next two to three decades, all efforts must be put in a closer interdisciplinary dialogue between biogerontologists and geriatricians to enable real-life measures of aging phenotypes to be used to uncover the physiological - and therefore translational - relevance of newly discovered aging clocks, biomarkers, and hallmarks.